Juvenile Idiopathic Arthritis (JIA)

Juvenile Idiopathic Arthritis (JIA)

Unless otherwise cited, the following
information has been gathered from
The Arthritis Society.

          When the term 'arthritis' comes to mind, we usually think of it as a disease
          that older people get. Unfortunately, this is not always the case. Even
          children can develop this condition resulting in pain, stiffness, swelling,
          fatigue and sometimes even eye inflammation and/or changes in growth.

 Definition

          Juvenile: young, 16 years of age or younger

          Idiopathic: of unknown cause
          Arthritis: inflammation in the joints, the places where bones come together

Did you know:

 Adult arthritis and JIA are not necessarily
 the same disease. There are some types
 of arthritis in adults that are not common
 in  children and some types of arthritis in 
 children that do not occur in adults.






           Although there are many more categories of JIA, the three most common 
           types, as described by Gillette Children’s Specialty Healthcare, are:

     Oligoarticular

• Four or fewer joints affected
• usually large joints (knees, ankles, elbows)
• often on one side of the body only
• found more often in girls than in boys
• increased risk of eye inflammation called iritis

        
      Polyarticular

• Five or more joints affected
• Usually small joints (hands and feet), weight bearing joints (knees, ankles, feet) and neck and jaw joints
• Often affects the same joints on both sides of the body

     Systemic (Still’s disease)

• Many areas of the body are affected, including joints and internal organs
• Causes a rash of pale red spots, often on the trunk or limbs
• Causes spiking fevers
• Affects boys and girls equally
• Least common form of JIA

Picture from: Arizona State University

http://www.asu.edu/courses/css335/JRASignsandSymptoms.html

                    The picture above shows both a healthy and an arthritic knee joint. 

                    In a healthy joint, the capsule lining makes a fluid that keeps the joint
                    slippery, so that the bones can move easily without friction. 

                    In the diseased joint, this lining becomes inflamed and thickened. 

                    It then produces extra fluid, but this fluid contains inflammatory cells.

                    These are the cells that cause the symptoms of joint inflammation: 

        redness, swelling, warmth,  
        stiffness and  pain. 

                 If left untreated, this inflammation can
                 cause damage to the cartilage, which
                 is the smooth substance covering the
                 end of the bones, and damage to the bones     
                 themselves.

 Prevalence

                                    In Canada 1 in 1000 children (about 10,000) have JIA. 

                                                    75 % of these children are girls.

Etiology

 JIA is an autoimmune disease, which means
 the child’s immune system attacks her own
 healthy body tissues and cells rather than only
 infections and bad cells (tumours). Although
 the cause is unknown, it seems that a genetic
 predisposition may be a risk factor in developing
 JIA. Trauma, infections and excessive stress
 on the joints can worsen the symptoms.
                                                           Remissions do occur, when symptoms
                                                           disappear for a period of time (Gillette).

Assessment

               A child with joint pain and swelling will need to be assessed by a doctor. The
               following steps should all be included in order to make a correct diagnosis.

1.  History taking: The doctor will need to ask many questions in order to get an accurate   history of the child’s physical health, including prior health concerns as well as the more recent symptoms
2. Physical exam: This will include an examination of the whole body as well as the areas of concern
3. Blood tests: To rule out other illnesses, classify the type of JIA and predict the likelihood of developing iritis (Gillette)
4. Imaging studies: X-rays, bone scans, ultrasound, MRI and bone density tests provide information about the child’s bones, joints and other organs to help with the diagnosis

                          Medical Intervention and Therapy

            Doctors will prescribe medical intervention
            and therapy as needed. Physical and
            Occupational therapists will  help to teach
            and implement therapy and comfort
            measures for maximum benefit to the
            child with JIA.

• Medications: Although there is no cure yet for JIA, there are save and effective medications to help control the disease by decreasing inflammation, swelling and pain, preventing or decreasing damage to joints, and thereby increasing a child’s activity and exercise level. It will be important to take the medications exactly as prescribed by the doctor. Medications can cause side effects and these need to be discussed with the doctor.
• Surgery: May sometimes be necessary to release or remove tissue that is preventing adequate joint movement (Gillette).
• Exercise: Gentle, regular exercise can help protect further injury by strengthening the muscles and thereby increasing support for the joints. Exercise also encourages healing, increases energy level, improves mood and releases endorphins, the body’s natural pain relievers. Range of Motion (ROM) exercises include stretching and bending to reduce stiffness and maintain flexibility. Swimming or Yoga can be enjoyable ROM exercises for a child. It’s important for a child to pace herself when doing exercises so she will do enough but not too much on a day which may result in too much pain afterwards.
• Braces, shoe inserts, or splints: Help to support joints and relieve pain (Gillette).
• Heat (hot water bottle, heating pack, heating lotions or gels, warm bath or shower): Applying heat increases blood circulation, feels soothing and can help relieve stiffness
• Cold (frozen gel pack or bag of frozen vegetables or ice cubes wrapped in a towel, cold cloth or compress, menthol-based gels or lotions): Applying cold can sooth red, swollen joints and has a numbing effect. It also decreases blood flow to swollen joints and decreases the activity of cells in the body.
• Heat and Cold: Alternating between heat and cold (20 minutes each) can provide more pain relieve for some children than either heat or cold by itself.
• Massage: Massage can stretch and loosen stiff muscles, helps decrease stress and helps to block pain signals from reaching the brain.

Developmental Consequences

• Joint inflammation changes the speed at which bones grow. This can cause abnormal bone and muscle development which in turn may affect the child’s motor skills.
• Eye inflammation can cause permanent damage to the eye if not treated (Gillette).  
• Children may at times feel angry, sad, embarrassed, isolated, inadequate, insecure and/or depressed (Arthritis Foundation).
• Pain may stop a child from doing the things he or she wants to do causing feelings of loneliness, sadness and stress.
• Social activities may be affected when the child’s motor skills are affected (Gillette).  
• Over protection and decreased expectations for the child by others may cause decreased independence in the child.   

                            

Educational Implications

         The Arthritis Foundation suggests
          the following strategies as a starting

          point to make the school experience

          the best it can be for children with arthritis.

•  The child’s parents, doctor, physical and occupational therapists can provide guidance on what he or she should or shouldn't do to promote optimum joint health
• Encourage the child to join in activities as he or she is able
• When hand joints are affected, the student may require foam grips on pens and pencils, electronic devices for writing assignments, copies of the teacher’s notes and alternative assessment of learning
• The child may need a special desk and chair
• He or she may need ‘stretch breaks’ to relieve stiffness
• A second set of school books eliminates the need for carrying books forth and back
• Include the child in planning the classroom environment
• Observe the child for signs of pain or fatigue
• Focus on his/her strengths rather than his/her limitations
• Encourage independence and responsibility
• Promote opportunities for social interactions and extracurricular activities that the child can join in
• The child may need an IEP to identify goals and necessary accommodations and modifications
• Home-based instruction may need to be arranged when the child has frequent absences from school
• Plan emergency drills that accommodate students with limited mobility
• Last, but not least, foster an environment of acceptance of diversity and individual differences at the school and in the classroom

                References

               The Arthritis Society

               http://www.arthritis.ca

               Arthritis Foundation

               http://www.arthritis.org/conditions-treatments/disease-center/juvenile- -arthritis/

               http://www.arthritis.org/ja-school-success.php

               Gillette Children’s Specialty Healthcare

                http://www.gillettechildrens.org/conditions-and-care/juvenile-idiopathic-arthritis-jia/